| Community Nutrition Action for Child Survival |
|Part I - Community nutrition problems and interventions|
|Unit 7: Family planning and nutrition|
Once couples know about and want to use family planning, they must be able to obtain an effective contraceptive method without excessive expenditures of time and money. Community-based programs can help couples obtain contraceptives and/or learn about natural family planning in several ways:
- Provide contraceptives in the community through a clinic or community workers
- Provide referral for contraceptive services and transportation to a nearby clinic
- Provide follow-up of contraceptive users to encourage continuation and solve problems with side effects
- Keep records of the eligible couples and family planning acceptors in the community
Trainees discuss the availability of family planning services in their areas and the socioeconomic barriers to the use of these services. The advantages of community-based distribution (CBD) of contraceptives are listed and the components of a CBD program discussed.
Time: 2 hours
- Handout - Case Study: Community-Based Family Planning Service Delivery
- Flipchart and marking pens
Time: 2 hours
1. Ask trainees to complete the following chart:
Where do people in your area currently go to obtain family planning services:
How far is this from village(s)?
Cost Round Trip
Time Round Trip
What methods are provided?
2. Discuss the effects that distance, cost and time for travel have on family planning acceptance and continuing use. Brainstorm other reasons why women who want to avoid pregnancy may not visit family planning clinics. These may include:
- Cultural restrictions on women's movement
- Negative attitudes toward family planning
- Poor treatment by health workers
- Lack of privacy
3. Role Play: Divide into work groups (5-6 people). Assign each work group the task of developing and presenting a role play based on the following situation:
Elizabeth has had four children. She and her husband have decided that they should wait for a few years before having another child. A family planning worker visited her several months ago and referred her to the clinic in Kisumu. Two months ago she traveled to Kisumu. Kisumu is 15 km away from Elizabeth's village. On most days the bus ride is about two hours. However, on the day she traveled to Kisumu, it was raining so hard that the bus became stuck and they arrived late. At the clinic, she was made to wait for a long time until she finally saw the nurse. It was so late when she finished that she had to wait until the next day to return to her village. Her husband was angry and accused her of lying about the wait at the clinic and the money she had spent on the bus and the contraceptives. The nurse gave Elizabeth three packages of oral contraceptive pills and told her that she must come back at the end of three months to get more.
In this role play, the family planning motivator is again visiting Elizabeth. Elizabeth explains to her why she has decided not to return to the clinic in Kisumu to fetch more contraceptives.
Trainer: Write your own role play situations based on local problems of transportation, culture! restrictions, health worker/client interactions, etc.
4. Case Study: Distribute the Handout - Case Study: "Community-Based Family Planning Service Delivery. " Ask trainees to read the case study individually and then to work with their groups to answer the questions et the end of the case study.
5. Go over the group's answers to the case study questions. Point out that community-based distribution:
- makes family planning methods easily available in the community;
- helps overcome geographic and financial barriers to contraceptive use;
- helps overcome restrictions on women's mobility and contact between female clients and workers;
- allows for rapid follow-up of "family planning acceptors to insure continuation of use.
6. Management Decisions: Review the important decisions managers must make when planning a CBD program:
- What contraceptives should be provided in the community
- Who should provide contraceptives in the community? (Selection, qualifications)
- What kind of training will community workers need? - How to supply and monitor contraceptive supplies?
- Where to refer? For what reasons? For v/hat services?
- How to supervise CBD workers?
7. Stress the importance of an effective referral system for any CBD project. The referral system must support the work of the community worker and provide clinical assessment and services as needed.
8. Summarize the unit:
Spacing births and limiting the size of a family means better health and nutrition for women and young children.
Modern and traditional methods of family planning make it possible for couples to have the number of children they can support.
Two important reasons why couples do not practice family planning are lack of information (or misinformation) and lack of access to contraceptives and contraceptive services.
Communities can play an important role in making information about family planning and contraceptive methods available to of their members.
Community-based family planning distribution programs can be organized with the active participation of community members to make contraceptive services available to all interested couples.
CASE STUDY: COMMUNITY-BASED FAMILY PLANNING SERVICE DELIVERY
Concerned Women for Family Planning was started in 1976 to provide family planning services to poor women living in the crowded slums of Dhaka, Bangladesh. The founders of the organization had come to realize that low-income women throughout the city were eager to obtain the baby preventing medicine" they had heard about but could not visit family planning clinics for a variety of reasons. In Bangladesh, the majority of women live in "prudish," or behind the veil. Their contacts are limited to the members of their families, and they seldom leave their own homes or compounds. Traveling to a family planning clinic, staffed by male and female workers, poses serious cultural as well as economic problems for most women.
To overcome these barriers, Concerned Women for Family Planning started a pilot program for the household distribution of family planning information and contraceptives. A team of four field assistants and one supervisor began working in a neighborhood of approximately 74,000 people. The neighborhood was divided into four sections, with each field assistant responsible for the families in one of the sections.
Field assistants began by visiting and getting to know the women in each of their sections. At the same time, they carried and distributed oral contraceptives and condoms and provided information on other clinical methods of family planning. Each field assistant eventually reached all of the homes in her section; however, more emphasis was placed on acceptor satisfaction and continuation than on the total number of new acceptors she recruited. Other programs had shown that many couples who decided to try family planning methods would discontinue use because of minor side effects or general dissatisfaction with the contraceptive method they had chosen. Concerned Women found that follow-up visits, during the first few months after a couple began using a contraceptive, would help them adjust to the method or change to a more satisfactory method without discontinuing family planning use.
Besides household distribution of contraceptives and active follow-up of acceptors, the Concerned Women's program provided referral and transportation to women who were interested in clinical family planning methods, sterilization, IUD insertion and Depo Provera injections. These clinical services were provided to clients referred by Concerned Women at two clinics in Dhaka.
During the first month of the Concerned Women project, 268 couples accepted family planning methods. Of these, 70 percent were still using family planning methods a year later. These high levels of acceptance and continuation proved that the Concerned Women's strategy worked!
Because of its success, the Concerned Women's program has continued to expand. By 1977, 88 field assistants and supervisors had been trained, and were providing information and delivering contraceptives house-to-house in 17 neighborhoods. In 1978, Concerned Women opened its women's clinic in the heart of the most crowded area of the old city, and the program is still growing. Today, the Concerned Women's program includes counseling, maternal/child health care, nutrition education as well as family planning services.
This case study describes an urban, community-based distribution program designed to overcome cultural restrictions on women's movement outside the home.
It is best to develop a case study for a program that increases access to family planning methods by overcoming the most important barriers in your region. For example, in rural areas, distance and cost of transportation may be major barriers to the acceptance of family planning.
CASE STUDY QUESTIONS
1. What barriers to family planning acceptance did the program in the case study overcome?
2. What family planning methods were provided in the community?
3. Where did the community workers (field assistants) refer clients for clinical services? What family planning methods and services were provided at these referral points?
4. Why do you think this program has been so successful?
(List as many possible reasons as you can think of.)
Baer, Edward C. and Winikoff, Beverly. Breastfeeding, Program. Policy and Research Issues, Studies in Family Planning, Vol. 12, No. 4, April 1981.
Center for Population and Family Health. Family Planning: Impact on the Health of Women and Children. Columbia University, 1981.
Favin, M., Bradford, B., and Abula, D. Improving Maternal Health in Developing Countries. World Federation of Public Health Associations. August, 1984.
Hatcher, Robert et. al. Contraceptive Technology 1984-1985. Irving Publishers, Inc., New York, 1985.